Most common presentation of infant with bilateral choanal atresia:
**Core Concept**
Bilateral choanal atresia is a congenital anomaly characterized by the blockage of the posterior nasal choanae, which are the passageways connecting the nasal cavity to the nasopharynx. This condition leads to respiratory distress in newborns, as they are obligate nasal breathers.
**Why the Correct Answer is Right**
The most common presentation of bilateral choanal atresia in infants is cyanosis and respiratory distress, particularly during crying or feeding. This occurs because the infant is unable to breathe through the nose and relies on oral breathing, which leads to increased work of breathing and oxygen desaturation. The obstruction of the choanae also leads to nasal regurgitation of milk during feeding, which can cause feeding difficulties.
**Why Each Wrong Option is Incorrect**
- **Option A:** Apnea is not a common presentation of bilateral choanal atresia, as the infant will attempt to breathe through the mouth.
- **Option B:** Stridor is more commonly associated with upper airway obstruction, such as laryngomalacia or subglottic stenosis.
- **Option C:** Vomiting is not a direct consequence of bilateral choanal atresia, although feeding difficulties can lead to aspiration and subsequent vomiting.
**Clinical Pearl / High-Yield Fact**
Bilateral choanal atresia is often associated with other congenital anomalies, such as CHARGE syndrome (coloboma, heart defects, atresia choanae, retardation of growth and development, genital hypoplasia, and ear anomalies).
**Correct Answer:** C. Cyanosis and respiratory distress during crying or feeding.